St Petersburg Nursing Home, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF1252096 Issued in FL

Legal business name

ST PETERSBURG NURSING HOME, LLC

Practice address

4250 66TH St N
Kenneth City, FL 33709-4918

Phone

(727) 546-2405

NPI assigned

Oct 31, 2005

Organization subpart

No

Name

Michelle Burdette

Title

Director of Finance

Phone

(423) 308-1845

Locations

• Jacaranda Manor Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366433385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4250 66TH ST N",
            "city": "KENNETH CITY",
            "state": "FL",
            "postal_code": "337094918",
            "telephone_number": "727-546-2405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4250 66TH ST N",
            "city": "KENNETH CITY",
            "state": "FL",
            "postal_code": "337094918",
            "telephone_number": "727-546-2405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST PETERSBURG NURSING HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BURDETTE",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "423-308-1845"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1252096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jacaranda Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Kenneth City, FL
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.